Definition of Cervical dysplasia:

Cervical dysplasia refers to abnormal changes in the cells on the surface of the cervix that are seen underneath a microscope. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.

Although these changes are not cancer, they can lead to cancer of the cervix if not treated.

Causes, incidence, and risk factors:

Most cases of cervical dysplasia occur in women ages 25 - 35, although it can develop at any age.

Almost all cases of cervical dysplasia or cervical cancer are caused by human papilloma virus (HPV). HPV is a common virus that is spread through sexual contact. There are many different types of HPV. Some types lead to cervical dysplasia or cancer.

The following may increase your risk of cervical dysplasia:

• Becoming sexually active before age 18
• Giving birth before age 16
• Having multiple sexual partners
• Having other illnesses or using medications that suppress your immune system
• Smoking

Symptoms:

There are usually no symptoms.

Signs and tests:

A pelvic examination is usually normal.

Cervical dysplasia that is seen on a Pap smear is called squamous intraepithelial lesion (SIL). These changes may be graded as:

• Low-grade (LSIL)
• High-grade (HSIL)
• Possibly cancerous (malignant)

If a Pap smear shows abnormal cells or cervical dysplasia, further testing or monitoring will be recommended:

• Follow-up Pap smears may be recommended for mild cases
• Colposcopy-directed biopsy can confirm the condition
• Cone biopsy may be done after colposcopy

Dysplasia that is seen on a biopsy of the cervix is called cervical intraepithelial neoplasia (CIN). It is grouped into three categories:

• CIN I -- mild dysplasia
• CIN II -- moderate to marked dysplasia
• CIN III -- severe dysplasia to carcinoma in situ

Some strains of human papillomavirus (HPV) are known to cause cervical cancer. An HPV DNA test can identify the high-risk types of HPV linked to such cancer. This may be done:

• As a screening test for women over age 30
• For women of any age who have a slightly abnormal Pap test result

Treatment:

Treatment depends on the degree of dysplasia. Mild dysplasia (LSIL or CIN I) may go away on its own.

• You may only need careful observation by your doctor with repeat Pap smears every 3 - 6 months.
• If the changes do not go away or get worse, treatment is necessary.

Treatment for moderate-to-severe dysplasia or mild dysplasia that does not go away may include:

• Cryosurgery to freeze abnormal cells
• Laser therapy, which uses light to burn away abnormal tissue
• LEEP (loop electrosurgical excision procedure), which uses electricity to remove abnormal tissue (See: Electrocauterization)
• Surgery to remove the abnormal tissue (cone biopsy)

Rarely, a hysterectomy may be needed. Women treated for dysplasia need close follow-up, usually every 3 to 6 months or as recommended by their provider.

Expectations (prognosis):

Early diagnosis and prompt treatment cure nearly all cases of cervical dysplasia. Sometimes, the condition returns.

Without treatment, severe cervical dysplasia may develop invasive cancer. It can take 10 or more years for cervical dysplasia to develop into cancer. The risk of cancer is lower for mild dysplasia.

Calling your health care provider:

Call for an appointment with your health care provider if you are age 21 or older and have never had a pelvic examination and Pap smear.

See: Physical exam frequency

Prevention:

Ask your health care provider about the HPV vaccine. Girls who receive this vaccine before they become sexually active reduce their chance of getting cervical cancer by 70%.

You can reduce your risk of developing cervical dysplasia by taking the following steps:

• Do not smoke. Smoking increases your risk of developing more severe dysplasia and cancer
• Get vaccinated for HPV between ages 9 and 26
• Do not have sex until you are 18 or older
• Practice safe sex, and use a condom
• Practice monogamy, which means you only have one sexual partner at a time